<%@ page contentType="text/html;charset=UTF-8" %>
<%@ include file="/WEB-INF/views/include/taglib.jsp"%>
<html>
<head>
	<title>产房建卡接种记录管理</title>
	<meta name="decorator" content="default"/>
	<script type="text/javascript">
		$(document).ready(function() {
			//$("#name").focus();
			$("#inputForm").validate({
				submitHandler: function(form){
					loading('正在提交，请稍等...');
					form.submit();
				},
				errorContainer: "#messageBox",
				errorPlacement: function(error, element) {
					$("#messageBox").text("输入有误，请先更正。");
					if (element.is(":checkbox")||element.is(":radio")||element.parent().is(".input-append")){
						error.appendTo(element.parent().parent());
					} else {
						error.insertAfter(element);
					}
				}
			});
		});
	</script>
</head>
<body>
	<ul class="nav nav-tabs">
		<li><a href="${ctx}/born/childVaccRecordTemp/">产房建卡接种记录列表</a></li>
		<li class="active"><a href="${ctx}/born/childVaccRecordTemp/form?id=${childVaccRecordTemp.id}">产房建卡接种记录<shiro:hasPermission name="born:childVaccRecordTemp:edit">${not empty childVaccRecordTemp.id?'修改':'添加'}</shiro:hasPermission><shiro:lacksPermission name="born:childVaccRecordTemp:edit">查看</shiro:lacksPermission></a></li>
	</ul><br/>
	<form:form id="inputForm" modelAttribute="childVaccRecordTemp" action="${ctx}/born/childVaccRecordTemp/save" method="post" class="form-horizontal">
		<form:hidden path="id"/>
		<sys:message content="${message}"/>		
		<div class="control-group">
			<label class="control-label">儿童ID：</label>
			<div class="controls">
				<form:input path="childid" htmlEscape="false" maxlength="32" class="input-xlarge required"/>
				<span class="help-inline"><font color="red">*</font> </span>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗ID：</label>
			<div class="controls">
				<form:input path="vaccineid" htmlEscape="false" maxlength="50" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">第几针：</label>
			<div class="controls">
				<form:input path="dosage" htmlEscape="false" maxlength="50" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">接种日期：</label>
			<div class="controls">
				<input name="vaccinatedate" type="text" readonly="readonly" maxlength="20" class="input-medium Wdate "
					value="<fmt:formatDate value="${childVaccRecordTemp.vaccinatedate}" pattern="yyyy-MM-dd HH:mm:ss"/>"
					onclick="WdatePicker({dateFmt:'yyyy-MM-dd HH:mm:ss',isShowClear:false});"/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">接种部位：</label>
			<div class="controls">
				<form:input path="bodypart" htmlEscape="false" maxlength="20" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗批号：</label>
			<div class="controls">
				<form:input path="batch" htmlEscape="false" maxlength="20" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">接种单位编码：</label>
			<div class="controls">
				<form:input path="office" htmlEscape="false" maxlength="50" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">医生姓名：</label>
			<div class="controls">
				<form:input path="doctor" htmlEscape="false" maxlength="20" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">创建时间：</label>
			<div class="controls">
				<input name="createdate" type="text" readonly="readonly" maxlength="20" class="input-medium Wdate "
					value="<fmt:formatDate value="${childVaccRecordTemp.createdate}" pattern="yyyy-MM-dd HH:mm:ss"/>"
					onclick="WdatePicker({dateFmt:'yyyy-MM-dd HH:mm:ss',isShowClear:false});"/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗价格：</label>
			<div class="controls">
				<form:input path="price" htmlEscape="false" maxlength="50" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">状态 0：未接种  1：已接种9删除：</label>
			<div class="controls">
				<form:input path="status" htmlEscape="false" maxlength="1" class="input-xlarge required"/>
				<span class="help-inline"><font color="red">*</font> </span>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗大类名称：</label>
			<div class="controls">
				<form:input path="vaccBigname" htmlEscape="false" maxlength="200" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗 名称：</label>
			<div class="controls">
				<form:input path="vaccName" htmlEscape="false" maxlength="30" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗厂家：</label>
			<div class="controls">
				<form:input path="manufacturer" htmlEscape="false" maxlength="50" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">对应产品id：</label>
			<div class="controls">
				<form:input path="productid" htmlEscape="false" maxlength="32" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">nid：</label>
			<div class="controls">
				<form:input path="nid" htmlEscape="false" maxlength="32" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">出生日期当天接种的：0不是   1是：</label>
			<div class="controls">
				<form:input path="sign" htmlEscape="false" maxlength="2" class="input-xlarge required"/>
				<span class="help-inline"><font color="red">*</font> </span>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">疫苗厂家编码：</label>
			<div class="controls">
				<form:input path="manufacturercode" htmlEscape="false" maxlength="200" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">数据来源,0：登记台 1：微信 2：一体机3:补录4.五联拆解  5.麻风隐藏：</label>
			<div class="controls">
				<form:input path="source" htmlEscape="false" maxlength="200" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">保险0未买1已买：</label>
			<div class="controls">
				<form:input path="insurance" htmlEscape="false" maxlength="10" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">付款状态 0：未付款1：已付款：</label>
			<div class="controls">
				<form:input path="paystatus" htmlEscape="false" maxlength="2" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">接种类型：</label>
			<div class="controls">
				<form:input path="vacctype" htmlEscape="false" maxlength="2" class="input-xlarge required"/>
				<span class="help-inline"><font color="red">*</font> </span>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">是否异常反应0：无1有：</label>
			<div class="controls">
				<form:input path="iseffect" htmlEscape="false" maxlength="1" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">备注：</label>
			<div class="controls">
				<form:textarea path="remarks" htmlEscape="false" rows="4" maxlength="500" class="input-xxlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">localcode：</label>
			<div class="controls">
				<form:input path="localcode" htmlEscape="false" maxlength="32" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">orderno：</label>
			<div class="controls">
				<form:input path="orderno" htmlEscape="false" maxlength="32" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">签字状态：</label>
			<div class="controls">
				<form:input path="signature" htmlEscape="false" maxlength="2" class="input-xlarge required"/>
				<span class="help-inline"><font color="red">*</font> </span>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">替代疫苗：</label>
			<div class="controls">
				<form:input path="inocUnionCode" htmlEscape="false" maxlength="10" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">替代来源记录id：</label>
			<div class="controls">
				<form:input path="inocUnionRecord" htmlEscape="false" maxlength="32" class="input-xlarge "/>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label">已上报标记1，未上报标记0：</label>
			<div class="controls">
				<form:input path="upstatus" htmlEscape="false" maxlength="1" class="input-xlarge "/>
			</div>
		</div>
		<div class="form-actions">
			<shiro:hasPermission name="born:childVaccRecordTemp:edit"><input id="btnSubmit" class="btn btn-primary" type="submit" value="保 存"/>&nbsp;</shiro:hasPermission>
			<input id="btnCancel" class="btn" type="button" value="返 回" onclick="history.go(-1)"/>
		</div>
	</form:form>
</body>
</html>